Baxter’s Nerve Entrapment The Overlooked Cause of Chronic Heel Pain in Athletes

Introduction

Chronic heel pain is frequently diagnosed as plantar fasciitisbut what if the real cause lies deeper A recent case report published in Archives of Clinical and Experimental Orthopaedics highlights how Baxter’s nerve entrapment can mimic common foot conditions, leading to delayed diagnosis and prolonged discomfort. For more peer-reviewed orthopaedic research and clinical insights, visit https://www.exporthopaedicjournal.com/index.php/aceo and explore the latest evidence shaping musculoskeletal care. This blog summarizes a compelling case where a young athlete achieved complete pain relief after targeted diagnosis and treatment of Baxter’s nerve injury

Understanding Baxter’s Nerve Entrapment

Baxter’s nerve also known as the first branch of the lateral plantar nerve can become compressed near the medial heel. Originally described by Baxter and Thigpen in 1984, this condition remains underdiagnosed.

Why It’s Often Missed

• Symptoms resemble plantar fasciitis
• Standard X-rays often appear normal
• Pain worsens with activity rather than morning stiffness
• May coexist with heel spurs or prior foot surgery

According to the American Academy of Orthopaedic Surgeons, accurate differentiation between plantar fasciitis and nerve entrapment is critical for proper treatment planning and long-term recovery.

Case Summary: A 22-Year-Old Athlete’s Journey

The published case https://doi.org/10.29328/journal.aceo.1001012 describes a 22-year-old triathlete suffering from persistent medial heel pain for nine months.

Initial Challenges

• Diagnosed presumptively with plantar fasciitis
• Underwent heel spur surgery with temporary improvement
• Failed conservative treatments:
  • Rest and activity modification
  • Physical therapy
  • NSAIDs (Meloxicam)
  • Neuropathic medications (Pregabalin, Gabapentin)
• Minimal relief from plantar fascia steroid injection

Despite imaging studies showing mild changes, his symptoms persisted especially worsening pain throughout the day and numbness along the lateral plantar foot.

A detailed analysis can be found in our main journal article

Diagnostic Breakthrough: Ultrasound-Guided Baxter’s Nerve Block

Clinical examination revealed

• Tenderness distal to the medial calcaneal tuberosity
• Positive Phalen’s-type maneuver (inversion + plantar flexion)
• Diminished sensation in the lateral plantar region

An ultrasound-guided diagnostic block using bupivacaine and steroid was performed around the nerve.

Immediate Results

• Pre-procedure pain score: 7/10
• Post-procedure pain score: 0/10
• Sustained relief over 8 months
• Full return to running without limitations

This confirms the importance of targeted nerve blocks in chronic heel pain management.

Key Takeaways for Clinicians

• Consider nerve entrapment in recalcitrant heel pain
• Use high-resolution ultrasound for nerve visualization
• Diagnostic blocks can confirm the condition
• Early detection prevents unnecessary surgery

The American College of Radiology emphasizes appropriate imaging pathways to avoid misdiagnosis in musculoskeletal pain conditions, reinforcing the need for targeted imaging in chronic heel pain cases.

Broader Implications for Sports Medicine

Baxter’s nerve entrapment may account for up to 20% of chronic heel pain cases. In athletes and active individuals, delayed diagnosis can

• Prolong rehabilitation
• Reduce athletic performance
• Increase opioid dependence risks
• Lead to unnecessary surgical interventions

This case reinforces the importance of anatomical knowledge, clinical suspicion, and precision-guided interventions in orthopaedic practice.

Explore more musculoskeletal research and case reports at exporthopaedicjournal to stay updated with advancements in orthopaedic diagnostics and pain management.

Conclusion

This case demonstrates that not all heel pain is plantar fasciitis. Baxter’s nerve injury should remain high on the differential diagnosis list especially in patients with persistent symptoms despite standard therapy.

Accurate diagnosis, ultrasound-guided nerve blocks, and early intervention can restore function and dramatically improve quality of life.

Call to Action

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